| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,087 |
4,898 |
$109K |
| D1120 |
Prophylaxis - child |
3,408 |
3,299 |
$102K |
| D0274 |
Bitewings - four radiographic images |
2,811 |
2,714 |
$84K |
| D1110 |
Prophylaxis - adult |
1,839 |
1,754 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,081 |
3,912 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,780 |
1,516 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
454 |
254 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,383 |
1,323 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
99 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,034 |
692 |
$10K |
| D0330 |
Panoramic radiographic image |
108 |
104 |
$5K |
| D1351 |
Sealant - per tooth |
167 |
54 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
48 |
$1K |
| D1999 |
|
34 |
33 |
$0.00 |